Provider Demographics
NPI:1124619754
Name:CARTER, ANTONESHA
Entity type:Individual
Prefix:
First Name:ANTONESHA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 BUFFALO SPEEDWAY APT 6206
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2558
Mailing Address - Country:US
Mailing Address - Phone:414-531-8105
Mailing Address - Fax:
Practice Address - Street 1:10201 BUFFALO SPEEDWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2561
Practice Address - Country:US
Practice Address - Phone:414-531-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No253Z00000XAgenciesIn Home Supportive Care